NEW RISK FACTORS AND AREAS OF RESEARCH


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Why do Indians get belly fat, diabetes and heart disease?

Dr Rajan Bowri BSc MBBS MRCGP

A simple, practical guide to reducing the risk of coronary heart disease and diabetes in people from India, Pakistan and Bangladesh

From the introduction:

In the last three decades, there has been a huge rise in the incidence of coronary heart disease (CHD) amongst South Asians, not only in the Indian Sub-Continent of India, Pakistan, Bangladesh and Sri Lanka, but also those who have migrated to Western countries such as Britain, Canada and the USA. Until recently, the reasons behind this increase were poorly known.

Since the 1960s, doctors have begun to understand better some of the risks and causes of coronary heart disease in the original White population of Western countries. Some factors such as getting older, being male, and having a family history of heart disease are important but can't be changed. But we have also realised that other factors such as smoking, obesity, high cholesterol, high blood pressure and lack of exercise are relevant, and can be improved with medication and changes in lifestyle. Governments and other organisations have made efforts to reduce the risk through education and other public health measures. It is thought that these efforts are beginning to pay off, and rates of heart disease in the White population have started to fall.
Unfortunately, the same success has not been realised amongst the South Asian population, where heart disease continues to rise. We are now seeing friends and relatives affected with angina and heart attacks in their fifties, forties, and even thirties. Doctors have suggested all sorts of causes, for example the stress of moving to a new country or facing racism, a diet high in certain fats such as ghee (clarified butter), and a tendency to develop diabetes. I think it is fair to say that we simply don't know for sure why Asians seem more prone, and there probably isn’t a single reason. However, in the last few years we are beginning to develop more ideas as a result of new research.

One of the most promising theories to emerge is that South Asians are at risk because they have a greater tendency to put weight on around the middle (the belly and the chest), even though they might not be particularly heavy generally. This belly fat interferes with the functioning of insulin, a hormone that controls blood sugar. This increases the risk of developing diabetes and pre-diabetes (also called insulin-resistance) which can damage blood vessels and lead to heart disease.

In this book I outline some of the causes and risks for coronary heart disease in South Asians and give you some practical advice on measures you can take to try to reduce your chances of developing heart problems in the future. The good news is that the same measures can also help to reduce the incidence of diabetes and stroke, bring down blood pressure and weight, and (perhaps surprisingly) slow the age-related decline in memory and potency, all contributing towards a longer, healthier life. I hope it will be of use and interest not only to readers of South Asian origin in the Indian Sub-continent and abroad, but also to their doctors. It is also relevant to non-Asian people who are at an increased risk of heart disease as a result of belly fat.

About the author:

Dr Bowri is a General Practitioner working in the UK. He graduated from the University of London with degrees in Immunology and Medicine. Within his practice, he has interests in diabetes, heart disease prevention and occupational medicine.

Table of Contents

Introduction
Important information (disclaimer)
What is coronary heart disease?
Prevalence, or how big is the problem?
Explanations for differences
Conventional unmodifiable risks
High blood pressure (or hypertension)
Action points - top tips about blood pressure
How to reduce your salt intake
Smoking
Weight
Weight distribution and Insulin Resistance – Apples and Pears
Waist circumference
The metabolic syndrome
Top tips on preventing and treating metabolic syndrome
Diabetes
Raised cholesterol
Inactivity
Alcohol
Food and diet
Problems with South Asian diets
New risk factors and areas of research
Inflammation and endothelial dysfunction
Vitamin D
Stress and sleep disturbance
Summary and advice tips
Notes, further reading and browsing
More technical reference


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